A study recently published
in the New England Journal of Medicine suggests that drug stocks
of neighborhood pharmacies are dictated not by legitimate demand but by
the racial composition of the neighborhood served. The study, which surveyed
347 pharmacies throughout New York City, revealed that most pharmacies
located in predominantly non-white neighborhoods did not stock opioid analgesics,
or painkillers, in quantities sufficient to meet legitimate demand. Over
half, or 51 percent, did not have adequate medication in stock to treat
a person in severe pain. Even when adjusted for age (which correlates with
the prevalence of terminal illness and painful chronic conditions) and
rates of burglary, robbery, and drug-related arrests, the results demonstrate
that pharmacies in non-white neighborhoods are less likely to stock opioids
than are pharmacies in white neighborhoods. In neighborhoods where the
majority of residents are African American, Hispanic, or Asian, patients
in pain and bearing prescriptions for painkillers often are forced to leave
the neighborhood in order to get the medicine they need.

Opioid supplies did not differ
significantly between chain and independent pharmacies. It is worth noting
that ownership does not appear to make a difference. Those pharmacists
representing chain pharmacies reported no specific corporate policies with
regard to stocking opioids.

The collective failure of
pharmacies to equitably ensure availability of painkillers to meet demand
is further evidence that members of ethnic minorities are at substantial
risk for the undertreatment of pain. Race is a proven factor in the treatment
strategies prescribed by physicians. A study of Medicare beneficiaries
found that physicians tend to prescribe less intensive or aggressive treatments
for African Americans than for similarly situated white Americans. Another
study found that Hispanics and African Americans were substantially undertreated
for pain from fractures of long bones. Yet another found that postoperative
pain was inadequately managed if the patient was not white. Whites are
more likely than nonwhites to receive prescriptions for painkillers. The
study of pharmacies in New York clearly demonstrates that whites also enjoy
more convenience in filling those prescriptions.

The results of this study
are consistent with evidence of a widening gap between the health status
of white Americans and that of non-white Americans. The statistics should
be familiar by now: African Americans have a higher overall incidence of
cancer and a higher rate of death from cancer than any other racial or
ethnic group. In "new" cases of AIDS, Hispanics and African Americans are
grossly over-represented. In short, traditional measures prove that members
of racial and ethnic subpopulations suffer worse health than their white
counterparts. The gap is not easily explained, but the medical literature
on the subject implies that systemic racial bias is a factor. In the pursuit
of quality health care, nonwhites are more likely than whites to encounter
barriers to appropriate medical treatment and to suffer worse health.

Nationally, the pharmacy
industry is now on notice of its possible complicity in discrimination
by allowing racial biases and misconceptions to result in the uneven delivery
of health care to its customers. The results of this study should spur
industry representatives to launch a campaign aimed at educating pharmacists
about the moral pitfalls of discrimination by race and ethnicity and the
resulting injury to business in the form of lost revenue.